Compelling commentary on children's health

The idea that the iron in infant formula predisposes infants to constipation is perhaps the oldest urban legend kicking around pediatric offices.

The belief that iron in infant formula can create problems for babies may be an extension of the misery experienced by pregnant women when supplemented with iron. When they’ve experienced the effects of iron supplementation, new mothers will often take matters into their own hands. Pediatricians themselves desperate for relief from colicky parents will often gamble with the low-iron card. It’s estimated that low-iron formulas account for 9%-30% of elective infant formula sales in the United States.

So what are the facts? Let’s look at a typical 6 kilogram 3-month-old infant consuming an average of 28 ounces per day formula. An infant fed Enfamil Lipil low-iron receives 4.2 mg of iron per day. The same volume of standard Enfamil Lipil provides 10.1 mg of iron daily. It’s estimated that babies need about 1 mg of iron per kilogram of bodyweight. The baby in our example therefore requires 6 mg of iron daily. The Enfamil low-iron cuts our baby short.

For parents who like to live on the edge there’s Similac low-iron formula. It provides about one third of the iron available in Enfamil’s low-iron formula. In the case of our baby discussed above, Similac low-iron provides a meager 1.3 mg of iron per day.

So what’s the big deal? Iron happens to be very important for brain development. Studies have documented the long-lasting developmental effects of iron deficiency early in life. And what about the association between iron in formula and constipation? There isn’t one. This association was disproved in clinical studies some years back.

What’s important to take home here is the fact that standard infant formula contains appropriate levels of iron, not “extra” iron as is often assumed. Low-iron formula as you see from our example, puts babies at an unacceptably high risk for iron deficiency and should have no place in feeding babies.

It’s been suggested that low-iron formulas should be removed from the market. But so long as misconceptions about formula and constipation exist, there will be demand. And where there’s demand there’s a market.

The Wall Street Journal this morning reports that Gerber Products, Inc, the world’s largest and best known maker of baby food, may be for sale. Novartis, the parent company of Gerber, wants to spend more time making vaccines. It seems Nestle, the global 300-pound gorilla of infant nutrition, wants a stake in the American baby food market.

The baby food aisle at Babies R Us could get interesting. Organics are heating up and Earth’s Best is making a run for it based on their growing market share. Nestle, Gerber’s suitor, clearly has a growing interest in the use of probiotics in infant products. Mead Johnson Nutritionals, the makers of Enfamil Lipil, have made the case for DHA and ARA (long chained fats found to be important for brain and vision development) in infant formula. There’s even the suggestion that DHA and ARA are important beyond a baby’s first birthday when infant formulas aren’t used.

Growing up I can remember spending long evenings with my mother at our dining room table toiling over homework. The one-on-one experience not only helped me solve the tough problems that I wasn’t able to tackle but also stressed the importance of hard work, commitment and getting it right.

It seems times have changed. The latest thing seems to be the outsourcing of homework and tutoring to India. That’s right, for as little as $2.50 an hour mom and dad don’t have to miss a minute of Desperate Housewives or Grey’s Anatomy. Just apply the phone receiver to junior’s sweaty muzzle and off you go. For more information on this curious trend tune in to think:lab’s Can My Outsourced Tutor Come Out and Play?

When it comes to media coverage of the obesity epidemic it seems the voice of NYU’s Marion Nestle is everywhere. In an article last week covering the Canadian angle on aggressive food marketing to kids, Dr. Nestle says “I want to see an environment that makes it easier for parents to do the right thing.”

This is reassuring for those parents who consider themselves victims of Big Food. I can't say that I agree, however. Irrespective of the amount of money food manufacturers spend on marketing, they’ve yet to find a way to make Twinkies jump into shopping carts on their own. When mom and dad don't buy it, it aint in the pantry.

We should have seen it coming: Wal-Mart clinics. And not just Wal-Mart clinics but CVS, Kroger, and Walgreen clinics to name but a few. Commonly known as retail based clinics (RBCs), these 9-5 clinics treat simple problems like ear infections, bronchitis and even provide immunizations. It’s estimated that over the next 10 years, RBCs will number nearly 10,000 in the United States.

Big box retail stores are the place for buying beef jerky and Tylenol in bulk. But when it comes to discerning early meningitis from a bad sinus infection in your child, traditional medical venues might be a better bet. All parents need to advocate for their children by seeking care in a medical home accustomed to treating kids.

The American Academy of Pediatrics last month published a statement critical of RBCs. The AAP policy cited a number of concerns surrounding retail pediatrics including fragmentation of care, lack of access to medical records, and deficient follow-up among other things.

Despite criticism, these clinics claim to fulfill an unmet need for fast, cheap care. Perhaps this is because caring for children isn’t best done fast & cheap. While RBCs may be fashionable now, parents will ultimately learn that this drive-through, fast food equivalent of pediatric care isn’t healthy.

Tara Parker Pope of the Wall Street Journal fell into the trap. The title of her November 21, 2006 Health Journalpiece promises “A Recipe For Coaxing Your Kids to Eat Their Vegetables.” Her column covers some basic feeding practices for parents but it was the coaxing that caught my attention.

The trap is this: The harder you work to get your child to eat, the less they tend to eat. And the less they eat the harder you push.

Most parents coax and most toddlers pick. Our impulse to coax is complicated but it’s driven by fear and supported by misunderstanding. We’re all afraid of what might happen if a meal is missed. Most of us don’t understand that toddlers and young children eat on their own terms in response to their own metabolism. So despite what we may believe or understand, children do best when left to their own devices.

The suggestion that children should be left alone while eating is the great paradox of the picky eater. Feeding therapist Ellyn Satter devised the Division of Responsibility which suggests that parents are responsible only for providing food and children are responsible for eating it. And the two should never cross. This is perhaps the single most powerful tip ever conceived for successful, healthy feeding.

Despite a title that suggests subtle coercion as a feeding policy, Tara Parker Pope redeems herself by encouraging readers not to bribe or threaten punishment. So it seems the real recipe is not to coax. But a title like that just wouldn't be as compelling.

Looking for that certain something to accent your son’s battery operated Harley Hogg on Christmas morning? The GR8 TaT2 maker may be exactly what you’re looking for. While holiday photos could have your kids looking like Dennis Rodman, don't underestimate the hours of fun they’ll have as they turn their bedroom into a tattoo parlor.

As appalling as this seems, I must confess that I let my son apply press-on tattoos all the time. Granted, none of them say “Hell’s Angels” or spell the name of that little girl he had an eye for in kindergarten. Either way, they’re tattoos. I guess in the case of this ad it’s my visceral response to the long, disheveled hair, reverse cami hat, tattoo gun and the Hell-bent look of determination on their faces. I'm verklempt.

Nedra Weinrich at Spare Change has an interesting post titled Little Things Count. She references a study from Penn’s Annenberg school that found differences in the description of the new human papillomavirus (HPV) vaccine influence whether women decide to receive it. When the vaccine is positioned as an anti-cancer measure they’re interested. If it is characterized as an anti-STD vaccine nearly a third choose to opt out.

This is important since moms are making vaccine decisions for their daughters. And independent of your opinion on the HPV vaccine, this study confirms that pediatricians are marketers. How we position our recommendations and our subtle choice of language influences the health and outcomes of our children.

What could be more annoying than a baby who spits up all the time? How about a baby who spits up purple?

Prevacid orally disintegrating tablets and capsules are becoming more commonly prescribed in infants with acid reflux. A number of mothers with refluxing babies in my practice have reported scant blueberry colored streaks in their baby’s regurgitation. It appears that the discoloration noted on these baby’s burp cloths comes from the coating of the time-released beads. Nothing to worry about.

So I’m talking with a patient-friend about Nursing Under the Influence and out of nowhere she casually reports having added breast milk to her coffee … on two occasions. “Not right,” I’m thinking to myself. Like the mother I spied chewing her newborn baby’s fingernails in the nursery. Endearing and nakedly human to some. Just gross to me.